Refugee mental health & providing effective support

Presenter: Maria Lo

November 8, 2016

Identify the social factors that impact on individuals’ health

Review the role of service providers in improving the holistic health status of their clients

Explain the causes of mental health challenges of refugees/immigrants using social determinants of health framework

Motivate clients to seek support (professional/caregiver) through active engagement skills

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The World Health Organization (WHO) constitution (1948) states:“Health is a state of complete physical, mental and social well-being and not merely the absence of Disease or Infirmity.”“resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.“(WHO,1986)

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WHO defines Mental Health:

“a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

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Factors that affect the mental health of immigrants and refugees which are beyond individual’s control: (Social determinants of health)

Income and social status

Education

Employment / Working conditions

Social environments

Physical environment

Healthy child development

Social support network

Source: The Public Health Agency of Canada

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• Adapting to a new culture

• Learning new language

• Coping with losses, i.e. family and social supports,

• Experiences of trauma before and after settlement

• Coping with discrimination

• Establishing the support network

• Unemployment and underemployment

• Changes in the socioeconomic status

• Seeking for culturally appropriate mental health care practices

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If I don`t have mental illness, I`m not affected by it.

True or False

Statement #1

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Mental illness strikes 1 out of 5 Canadians

All Canadians are affected by mental health issues or mental illness

FALSE

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Mental health factors, such as stress, anxiety, and

depression, don't affect your overall health as much

as physical factors.

True or False

Statement #2

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Your state of mind is connected to and shapes all other bodily states,

and needs equal attention. Excess stress increases the release of the

stress hormone cortisol, which can further increase blood sugar and

accelerate progression to diabetes. This illustrates stress can directly

affect your physical health.

Source:Mental Health Myths in South Asians

http://www.pamf.org/southasian/risk/concerns/mentalhealthmyths.html

FALSE

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Everyone has attitudes and judgments that affect how we think about and behave toward othersStigma refers to negative, unfavourable attitudes and the behaviour they produce. It is a form of prejudice that spreads fear and misinformation, labels individuals and perpetuates stereotypes.

Source: www.mentalhealthcommission.ca/English/Pages/OpeningMinds.aspx

Stigma:

prejudice and discrimination towards people with mental illness

misconceptions

discomfort with differences

fearing and avoiding what we don’t understand

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Many people living with a mental illness say the stigma they face is often worse than the illness itself.

Intertwined with and just as important as physical health

finding a balance in all aspects of your life

Finding a balance is a unique learning process

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•Biological•Environmental•Genetic

-Loss-Migration

-War-Trauma

•Access to adequate income, housing, employment, etc.•Community support•Coping ability•Personal strengths•Social inclusion•Social support

•Decreased health status•Inadequate housing•Inadequate income•Social exclusion•Stress•Unemployment

Physical &

Spiritual Health

Mental

Health

Source: Wong, J. P. (June 2006). Intersecting sexuality, gender, race & citizenship:

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Predisposing

Factors

Protective

Factors

Precipitating

Factors

Perpetuating

Factors

“In any given year, one in five people in Canada experiences a mental health problem or illness, with a cost to the economy of well in excess of $50 billion”

Source: Mental Health Commission of Canada. (2012). Changing directions, changing lives: The mental health strategy for Canada. Calgary, AB: Author.

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(not a check list or an exhaustive list)

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Physical symptom

s

Restlessness

Insomnia

Weight gain

or loss

Loss of appetite

Panic attacks

Poor concentra

tion

AngerCrying easily

Feelings of

sadnessLoss of

interest or motivation in

daily activitiesChanges in

relationships with family

members or peers

Does not automatically mean we have mental illness…

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An anxiety disorder

Produced by an extraordinarily stressful event

Re-experiencing of this event through flashbacks

and nightmares

2-5% of population

30% of veteran involved in war

Male to female ratio: 1:2

Age of onset: any age, including childhood

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What are the Symptoms?

Difficulty falling or staying asleep

Unwanted thoughts, memories, images or dreams about the event

Acting and feeling as if the traumatic event is happening again

Extreme vigilance – feeling watchful all the time and being easily startled

Extreme distress when something reminds the person of the event

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Learn about mental health in the context of holistic

health

Understand associated factors and taking early steps to

change

Practicing mental fitness

Assessment & early treatment

Exploring strategies in promoting mental health &

coping with stress

Organizational & systemic changes beyond the

individual level24

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Medical Psychosocial

Psychiatric Medication Electroconvulsive Therapy Psychotherapy

Group Day Program ACTT Vocational program Psychosocial Peer Support Case Management Alternative Treatment Other community support

As unique and individual that mental health issues and addictions are to each patient/client, so too are their assessment and

treatment needs. -CAMH

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“In general, immigrants and refugees are less likely than their Canadian-born counterparts to seek out or be referred to mental health services, even when they experience comparable levels of distress.”

(Chen AW, Kazanjian A., 2011)

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the Holistic Health Framework:

Significance of Access to Resources

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Cultural inclusive goes beyond linguistic competence and sharing the same country of origin

Presumptions, stereotypes, and playing the “expert” role can pose barriers to being culturally competent

Significance of culture as defined & perceived by the individual

Culture impacts on perception of mental health & mental illness

Stigma & its impact on help seeking behavior

It provides a culturally safe environment

Resource & Service Accessibility 29

• It is culturally relevant

• Address the social determinants

• Equitable access to services and programs

• Responsive to the needs of the clients’ groups

• Reflecting the diversity of the community that being

served

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CONNECTION BEFORE SOLUTION

EMPATHY BEFORE EDUCATION

Source: “Supporting Immigrants and Refugees in Distress Using

Tools from the Compassionate Communication™ Process” by

Mr. Henry Wai, NVC trainer

• Unemployment

• Poverty

• Social isolation

• Shame/guilt

• Racism and discrimination

• Language skills.¹

• Lack of mobility

• Inability to take time away from work

• Concern that problems will not be understood by practitioners because of cultural or linguistic differences. ²

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1. Sidher, 20112. Whitley R, Kirmayer LJ, Groleau D., 2006

• Engaging clients

• Early identification skills, assessment

• High-quality customer service provider

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I've learned that people will forget what you said,

people will forget what you did, but people will never forget how you made them feel.

Maya Angelou, author, poet, and activist

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• is attentive• concentrates on the client• does not interrupt• gives nonverbal feedback (e.g., nodding, smiling, saying

"mmm") • reflects and acknowledges feelings (e.g., "You sound very

happy today.")• summarizes the main points back to the speaker• asks for clarification when needed, using open-ended

questions• always asks questions in a non-judgmental way, using a

tone of voice that expresses interest and concern.

CAMH, 2012

Focus attention on the speaker. A good active listener:

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A peer support worker said,

“A smile can solve a thousand problems.”

1. Cultural identity2. Cultural explanations of illness3. Cultural practices regarding to psycho-social practices4. Cultural elements between patient and health care

provider. 5. Cultural assessment and care plan.

Dr. Kenneth Fung, 2013

A section of the DSM recognizes that everyone has a culture and the following factors should always be considered when working with clients:

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How people explain the causes of illnesses.

Ask to find out someone’s personal explanatory model of illness:

• What do you call the illness?

• Why does it exist/what caused it?

• Who should treat it?

• What treatment is needed?

The point to remember is that people can have the same illness, but experience it differently from each other.

Dr. Kenneth Fung, 2013

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Relating & Responding to Client: -Listening-Verbal & non-verbal communication (e.g. body language, )-Recognition & support V.s. Judging & Reasoning

Alternatives: - What’s Workable V.s. What’s not Workable- Strengths V.s. Problems- Hope V.s. Giving Up

Keep a needs-based focus.

Maintain confidentiality and safety.

Help empower clients.

Respect clients' self-determination and personal freedom.

Keep expectations realistic.

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CAMH

Working on Client’s positives & strengths v.s. fixating on problems that do not have immediate solutions

Setting contract & boundary with the client through a trusting & supportive relationship: Without trust, setting limits can turn into a power struggleWith trust, rapport & listening, we can support client to enhance coping & social skills as well as possibly working towards getting other types of support & treatment (e.g. psychiatric treatment, mental health support services)

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• Facilitate the initial interviews to occur

– e.g. reminder; transportation; interpretation

• Provide support

• Provide information

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Dr. Kenneth Fung, 2013

• Collaboratively identify the need and the most appropriate consultant(s) or service(s) and offer choice

• Clarify and implement the correct referral procedures

• Preparation for the consultation / services intake

– Who and what to bring?

– What to expect?

– Any barriers to going?

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• Follow-up with the client

• Follow-up on the consultant / services

• Facilitate next steps

• Circle of care/consent

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